|
BINDER ABDOMINAL 12 4-PANEL 30-45" S/M 13651056"
|
Facility
OP
|
$224.00
|
|
|
Service Code
|
HCPCS L0625
|
| Hospital Charge Code |
2969954
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.78 |
| Max. Negotiated Rate |
$896.00 |
| Rate for Payer: Aetna Commercial |
$201.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$192.64
|
| Rate for Payer: Aetna Managed Medicare |
$62.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.72
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$206.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$125.35
|
| Rate for Payer: Health EOS Commercial |
$199.36
|
| Rate for Payer: HFN Commercial |
$206.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$179.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.40
|
| Rate for Payer: Preferred Network Access Commercial |
$206.08
|
| Rate for Payer: Quartz Beloit One Network |
$109.76
|
| Rate for Payer: Quartz Commercial |
$145.60
|
| Rate for Payer: Quartz Medicare Advantage |
$134.40
|
| Rate for Payer: The Alliance Commercial |
$896.00
|
| Rate for Payer: WEA Trust Commercial |
$123.20
|
| Rate for Payer: WPS Commercial |
$165.92
|
|
|
BINDER ABDOMINAL 12 4-PANEL 46-62" M/L 13652067"
|
Facility
IP
|
$721.00
|
|
|
Service Code
|
HCPCS L0625
|
| Hospital Charge Code |
2963951
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$353.29 |
| Max. Negotiated Rate |
$663.32 |
| Rate for Payer: Aetna Commercial |
$648.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$382.13
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cigna Commercial |
$663.32
|
| Rate for Payer: Health EOS Commercial |
$641.69
|
| Rate for Payer: HFN Commercial |
$663.32
|
| Rate for Payer: Multiplan Commercial |
$576.80
|
| Rate for Payer: NAPHCARE Commercial |
$432.60
|
| Rate for Payer: Preferred Network Access Commercial |
$663.32
|
| Rate for Payer: Quartz Beloit One Network |
$353.29
|
| Rate for Payer: Quartz Commercial |
$432.60
|
| Rate for Payer: WEA Trust Commercial |
$396.55
|
| Rate for Payer: WPS Commercial |
$534.04
|
|
|
BINDER ABDOMINAL 12 4-PANEL 46-62" M/L 13652067"
|
Facility
OP
|
$721.00
|
|
|
Service Code
|
HCPCS L0625
|
| Hospital Charge Code |
2963951
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.78 |
| Max. Negotiated Rate |
$2,884.00 |
| Rate for Payer: Aetna Commercial |
$648.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$620.06
|
| Rate for Payer: Aetna Managed Medicare |
$201.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$382.13
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cigna Commercial |
$663.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$403.47
|
| Rate for Payer: Health EOS Commercial |
$641.69
|
| Rate for Payer: HFN Commercial |
$663.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$540.75
|
| Rate for Payer: Multiplan Commercial |
$576.80
|
| Rate for Payer: NAPHCARE Commercial |
$432.60
|
| Rate for Payer: Preferred Network Access Commercial |
$663.32
|
| Rate for Payer: Quartz Beloit One Network |
$353.29
|
| Rate for Payer: Quartz Commercial |
$468.65
|
| Rate for Payer: Quartz Medicare Advantage |
$432.60
|
| Rate for Payer: The Alliance Commercial |
$2,884.00
|
| Rate for Payer: WEA Trust Commercial |
$396.55
|
| Rate for Payer: WPS Commercial |
$534.04
|
|
|
BINDER ABDOMINAL 12 4-PANEL 63-74" L 13653008"
|
Facility
OP
|
$316.00
|
|
|
Service Code
|
HCPCS L0625
|
| Hospital Charge Code |
2963899
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.78 |
| Max. Negotiated Rate |
$1,264.00 |
| Rate for Payer: Aetna Commercial |
$284.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.76
|
| Rate for Payer: Aetna Managed Medicare |
$88.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$167.48
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$290.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$176.83
|
| Rate for Payer: Health EOS Commercial |
$281.24
|
| Rate for Payer: HFN Commercial |
$290.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$237.00
|
| Rate for Payer: Multiplan Commercial |
$252.80
|
| Rate for Payer: NAPHCARE Commercial |
$189.60
|
| Rate for Payer: Preferred Network Access Commercial |
$290.72
|
| Rate for Payer: Quartz Beloit One Network |
$154.84
|
| Rate for Payer: Quartz Commercial |
$205.40
|
| Rate for Payer: Quartz Medicare Advantage |
$189.60
|
| Rate for Payer: The Alliance Commercial |
$1,264.00
|
| Rate for Payer: WEA Trust Commercial |
$173.80
|
| Rate for Payer: WPS Commercial |
$234.06
|
|
|
BINDER ABDOMINAL 12 4-PANEL 63-74" L 13653008"
|
Facility
IP
|
$316.00
|
|
|
Service Code
|
HCPCS L0625
|
| Hospital Charge Code |
2963899
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$154.84 |
| Max. Negotiated Rate |
$290.72 |
| Rate for Payer: Aetna Commercial |
$284.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$167.48
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$290.72
|
| Rate for Payer: Health EOS Commercial |
$281.24
|
| Rate for Payer: HFN Commercial |
$290.72
|
| Rate for Payer: Multiplan Commercial |
$252.80
|
| Rate for Payer: NAPHCARE Commercial |
$189.60
|
| Rate for Payer: Preferred Network Access Commercial |
$290.72
|
| Rate for Payer: Quartz Beloit One Network |
$154.84
|
| Rate for Payer: Quartz Commercial |
$189.60
|
| Rate for Payer: WEA Trust Commercial |
$173.80
|
| Rate for Payer: WPS Commercial |
$234.06
|
|
|
BINDER ABDOMINAL 12 4-PANEL 75-84" XL 13654009"
|
Facility
IP
|
$260.00
|
|
|
Service Code
|
HCPCS L0625
|
| Hospital Charge Code |
4491020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$239.20 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$156.00
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$156.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.58
|
|
|
BINDER ABDOMINAL 12 4-PANEL 75-84" XL 13654009"
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
HCPCS L0625
|
| Hospital Charge Code |
4491020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.78 |
| Max. Negotiated Rate |
$1,040.00 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Aetna Managed Medicare |
$72.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$145.50
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$195.00
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$156.00
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$169.00
|
| Rate for Payer: Quartz Medicare Advantage |
$156.00
|
| Rate for Payer: The Alliance Commercial |
$1,040.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.58
|
|
|
BINDER ABDOMINAL 12 4-PANEL 85-94"X XL 13655010"
|
Facility
OP
|
$271.00
|
|
|
Service Code
|
HCPCS L0625
|
| Hospital Charge Code |
4491021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.78 |
| Max. Negotiated Rate |
$1,084.00 |
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.06
|
| Rate for Payer: Aetna Managed Medicare |
$75.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.63
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$249.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.65
|
| Rate for Payer: Health EOS Commercial |
$241.19
|
| Rate for Payer: HFN Commercial |
$249.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$203.25
|
| Rate for Payer: Multiplan Commercial |
$216.80
|
| Rate for Payer: NAPHCARE Commercial |
$162.60
|
| Rate for Payer: Preferred Network Access Commercial |
$249.32
|
| Rate for Payer: Quartz Beloit One Network |
$132.79
|
| Rate for Payer: Quartz Commercial |
$176.15
|
| Rate for Payer: Quartz Medicare Advantage |
$162.60
|
| Rate for Payer: The Alliance Commercial |
$1,084.00
|
| Rate for Payer: WEA Trust Commercial |
$149.05
|
| Rate for Payer: WPS Commercial |
$200.73
|
|
|
BINDER ABDOMINAL 12 4-PANEL 85-94"X XL 13655010"
|
Facility
IP
|
$271.00
|
|
|
Service Code
|
HCPCS L0625
|
| Hospital Charge Code |
4491021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$132.79 |
| Max. Negotiated Rate |
$249.32 |
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.63
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$249.32
|
| Rate for Payer: Health EOS Commercial |
$241.19
|
| Rate for Payer: HFN Commercial |
$249.32
|
| Rate for Payer: Multiplan Commercial |
$216.80
|
| Rate for Payer: NAPHCARE Commercial |
$162.60
|
| Rate for Payer: Preferred Network Access Commercial |
$249.32
|
| Rate for Payer: Quartz Beloit One Network |
$132.79
|
| Rate for Payer: Quartz Commercial |
$162.60
|
| Rate for Payer: WEA Trust Commercial |
$149.05
|
| Rate for Payer: WPS Commercial |
$200.73
|
|
|
Binocular Microscopy
|
Professional
|
$170.00
|
|
|
Service Code
|
CPT 92504
|
| Hospital Charge Code |
2566799
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146.20
|
| Rate for Payer: Aetna Managed Medicare |
$9.10
|
| Rate for Payer: Anthem Medicare Advantage |
$9.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.10
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$161.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$85.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.10
|
| Rate for Payer: Health EOS Commercial |
$154.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.10
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Preferred Network Access Commercial |
$161.50
|
| Rate for Payer: Quartz Beloit One Network |
$74.80
|
| Rate for Payer: Quartz Commercial |
$96.90
|
| Rate for Payer: Quartz Medicare Advantage |
$9.10
|
| Rate for Payer: The Alliance Commercial |
$22.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.10
|
| Rate for Payer: WEA Trust Commercial |
$93.50
|
| Rate for Payer: WPS Commercial |
$36.40
|
|
|
BIO A TISSUE REINFO 7cm X 10cm
|
Facility
IP
|
$5,796.00
|
|
| Hospital Charge Code |
2967378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,840.04 |
| Max. Negotiated Rate |
$5,332.32 |
| Rate for Payer: Aetna Commercial |
$5,216.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,071.88
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cigna Commercial |
$5,332.32
|
| Rate for Payer: Health EOS Commercial |
$5,158.44
|
| Rate for Payer: HFN Commercial |
$5,332.32
|
| Rate for Payer: Multiplan Commercial |
$4,636.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,477.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,332.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,840.04
|
| Rate for Payer: Quartz Commercial |
$3,477.60
|
| Rate for Payer: WEA Trust Commercial |
$3,187.80
|
| Rate for Payer: WPS Commercial |
$4,293.10
|
|
|
BIO A TISSUE REINFO 7cm X 10cm
|
Facility
OP
|
$5,796.00
|
|
| Hospital Charge Code |
2967378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,622.88 |
| Max. Negotiated Rate |
$23,184.00 |
| Rate for Payer: Aetna Commercial |
$5,216.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,984.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,622.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,767.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,898.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,782.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,071.88
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cigna Commercial |
$5,332.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,243.44
|
| Rate for Payer: Health EOS Commercial |
$5,158.44
|
| Rate for Payer: HFN Commercial |
$5,332.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,347.00
|
| Rate for Payer: Multiplan Commercial |
$4,636.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,477.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,332.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,840.04
|
| Rate for Payer: Quartz Commercial |
$3,767.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,477.60
|
| Rate for Payer: The Alliance Commercial |
$23,184.00
|
| Rate for Payer: WEA Trust Commercial |
$3,187.80
|
| Rate for Payer: WPS Commercial |
$4,293.10
|
|
|
BIOFDBK TRNG PERI/URO/RECT w/EMG and/or MANOMTY 15 MIN 90912
|
Professional
|
$162.00
|
|
|
Service Code
|
CPT 90912
|
| Hospital Charge Code |
5561225
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.23 |
| Max. Negotiated Rate |
$164.92 |
| Rate for Payer: Aetna Commercial |
$153.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.32
|
| Rate for Payer: Aetna Managed Medicare |
$41.23
|
| Rate for Payer: Anthem Medicare Advantage |
$41.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.23
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$153.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.23
|
| Rate for Payer: Health EOS Commercial |
$147.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.23
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: Preferred Network Access Commercial |
$153.90
|
| Rate for Payer: Quartz Beloit One Network |
$71.28
|
| Rate for Payer: Quartz Commercial |
$92.34
|
| Rate for Payer: Quartz Medicare Advantage |
$41.23
|
| Rate for Payer: The Alliance Commercial |
$103.08
|
| Rate for Payer: United Healthcare Medicaid |
$62.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.23
|
| Rate for Payer: WEA Trust Commercial |
$89.10
|
| Rate for Payer: WPS Commercial |
$164.92
|
|
|
Biofeedback Training: Perineal Muscles, Anorectal Or urethral Sphincter
|
Professional
|
$311.00
|
|
| Hospital Charge Code |
1190815
|
| Min. Negotiated Rate |
$136.84 |
| Max. Negotiated Rate |
$295.45 |
| Rate for Payer: Aetna Commercial |
$295.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$267.46
|
| Rate for Payer: Cash Price |
$93.30
|
| Rate for Payer: Cigna Commercial |
$295.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$155.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.60
|
| Rate for Payer: Health EOS Commercial |
$283.01
|
| Rate for Payer: Multiplan Commercial |
$248.80
|
| Rate for Payer: Preferred Network Access Commercial |
$295.45
|
| Rate for Payer: Quartz Beloit One Network |
$136.84
|
| Rate for Payer: Quartz Commercial |
$177.27
|
| Rate for Payer: The Alliance Commercial |
$155.50
|
| Rate for Payer: WEA Trust Commercial |
$171.05
|
| Rate for Payer: WPS Commercial |
$230.36
|
|
|
BIOFREEZE 360 SPRAY 4oz 081697374
|
Facility
IP
|
$218.00
|
|
| Hospital Charge Code |
2969697
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$106.82 |
| Max. Negotiated Rate |
$200.56 |
| Rate for Payer: Aetna Commercial |
$196.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.54
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$200.56
|
| Rate for Payer: Health EOS Commercial |
$194.02
|
| Rate for Payer: HFN Commercial |
$200.56
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: NAPHCARE Commercial |
$130.80
|
| Rate for Payer: Preferred Network Access Commercial |
$200.56
|
| Rate for Payer: Quartz Beloit One Network |
$106.82
|
| Rate for Payer: Quartz Commercial |
$130.80
|
| Rate for Payer: WEA Trust Commercial |
$119.90
|
| Rate for Payer: WPS Commercial |
$161.47
|
|
|
BIOFREEZE 360 SPRAY 4oz 081697374
|
Facility
OP
|
$218.00
|
|
| Hospital Charge Code |
2969697
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$61.04 |
| Max. Negotiated Rate |
$872.00 |
| Rate for Payer: Aetna Commercial |
$196.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.48
|
| Rate for Payer: Aetna Managed Medicare |
$61.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$109.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.54
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$200.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.99
|
| Rate for Payer: Health EOS Commercial |
$194.02
|
| Rate for Payer: HFN Commercial |
$200.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$163.50
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: NAPHCARE Commercial |
$130.80
|
| Rate for Payer: Preferred Network Access Commercial |
$200.56
|
| Rate for Payer: Quartz Beloit One Network |
$106.82
|
| Rate for Payer: Quartz Commercial |
$141.70
|
| Rate for Payer: Quartz Medicare Advantage |
$130.80
|
| Rate for Payer: The Alliance Commercial |
$872.00
|
| Rate for Payer: WEA Trust Commercial |
$119.90
|
| Rate for Payer: WPS Commercial |
$161.47
|
|
|
BIOFREEZE 4oz TUBE
|
Facility
IP
|
$355.00
|
|
| Hospital Charge Code |
2969696
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$173.95 |
| Max. Negotiated Rate |
$326.60 |
| Rate for Payer: Aetna Commercial |
$319.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.15
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$326.60
|
| Rate for Payer: Health EOS Commercial |
$315.95
|
| Rate for Payer: HFN Commercial |
$326.60
|
| Rate for Payer: Multiplan Commercial |
$284.00
|
| Rate for Payer: NAPHCARE Commercial |
$213.00
|
| Rate for Payer: Preferred Network Access Commercial |
$326.60
|
| Rate for Payer: Quartz Beloit One Network |
$173.95
|
| Rate for Payer: Quartz Commercial |
$213.00
|
| Rate for Payer: WEA Trust Commercial |
$195.25
|
| Rate for Payer: WPS Commercial |
$262.95
|
|
|
BIOFREEZE 4oz TUBE
|
Facility
OP
|
$355.00
|
|
| Hospital Charge Code |
2969696
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$99.40 |
| Max. Negotiated Rate |
$1,420.00 |
| Rate for Payer: Aetna Commercial |
$319.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$305.30
|
| Rate for Payer: Aetna Managed Medicare |
$99.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$230.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$177.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.15
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$326.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.66
|
| Rate for Payer: Health EOS Commercial |
$315.95
|
| Rate for Payer: HFN Commercial |
$326.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$266.25
|
| Rate for Payer: Multiplan Commercial |
$284.00
|
| Rate for Payer: NAPHCARE Commercial |
$213.00
|
| Rate for Payer: Preferred Network Access Commercial |
$326.60
|
| Rate for Payer: Quartz Beloit One Network |
$173.95
|
| Rate for Payer: Quartz Commercial |
$230.75
|
| Rate for Payer: Quartz Medicare Advantage |
$213.00
|
| Rate for Payer: The Alliance Commercial |
$1,420.00
|
| Rate for Payer: WEA Trust Commercial |
$195.25
|
| Rate for Payer: WPS Commercial |
$262.95
|
|
|
BIOGLUE SYRINGE 5ML BG3515-5-US
|
Facility
OP
|
$5,940.00
|
|
|
Service Code
|
HCPCS A4364
|
| Hospital Charge Code |
2965000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,663.20 |
| Max. Negotiated Rate |
$5,464.80 |
| Rate for Payer: Aetna Commercial |
$5,346.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,108.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,663.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,861.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,970.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,851.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,148.20
|
| Rate for Payer: Cash Price |
$1,782.00
|
| Rate for Payer: Cigna Commercial |
$5,464.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,324.02
|
| Rate for Payer: Health EOS Commercial |
$5,286.60
|
| Rate for Payer: HFN Commercial |
$5,464.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,455.00
|
| Rate for Payer: Multiplan Commercial |
$4,752.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,564.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,464.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,910.60
|
| Rate for Payer: Quartz Commercial |
$3,861.00
|
| Rate for Payer: Quartz Medicare Advantage |
$3,564.00
|
| Rate for Payer: WEA Trust Commercial |
$3,267.00
|
| Rate for Payer: WPS Commercial |
$4,399.76
|
|
|
BIOGLUE SYRINGE 5ML BG3515-5-US
|
Facility
IP
|
$5,940.00
|
|
|
Service Code
|
HCPCS A4364
|
| Hospital Charge Code |
2965000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,910.60 |
| Max. Negotiated Rate |
$5,464.80 |
| Rate for Payer: Aetna Commercial |
$5,346.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,148.20
|
| Rate for Payer: Cash Price |
$1,782.00
|
| Rate for Payer: Cigna Commercial |
$5,464.80
|
| Rate for Payer: Health EOS Commercial |
$5,286.60
|
| Rate for Payer: HFN Commercial |
$5,464.80
|
| Rate for Payer: Multiplan Commercial |
$4,752.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,564.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,464.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,910.60
|
| Rate for Payer: Quartz Commercial |
$3,564.00
|
| Rate for Payer: WEA Trust Commercial |
$3,267.00
|
| Rate for Payer: WPS Commercial |
$4,399.76
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC
|
Facility
IP
|
$63,693.00
|
|
|
Service Code
|
MS-DRG 478
|
| Min. Negotiated Rate |
$22,911.29 |
| Max. Negotiated Rate |
$63,693.00 |
| Rate for Payer: Aetna Managed Medicare |
$22,911.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49,932.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38,272.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36,361.64
|
| Rate for Payer: Anthem Medicare Advantage |
$22,911.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22,911.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22,911.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22,911.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40,364.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22,911.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46,482.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22,911.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22,911.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22,911.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22,911.29
|
| Rate for Payer: NAPHCARE Commercial |
$34,366.94
|
| Rate for Payer: Quartz Medicare Advantage |
$22,911.29
|
| Rate for Payer: The Alliance Commercial |
$63,693.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,911.29
|
| Rate for Payer: United Healthcare PPO |
$36,186.95
|
| Rate for Payer: Wellcare Medicare |
$22,911.29
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
IP
|
$89,889.00
|
|
|
Service Code
|
MS-DRG 477
|
| Min. Negotiated Rate |
$32,334.00 |
| Max. Negotiated Rate |
$89,889.00 |
| Rate for Payer: Aetna Managed Medicare |
$32,334.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70,702.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54,192.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51,486.86
|
| Rate for Payer: Anthem Medicare Advantage |
$32,334.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32,334.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32,334.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$32,334.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57,155.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$32,334.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65,695.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32,334.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32,334.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$32,334.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$32,334.00
|
| Rate for Payer: NAPHCARE Commercial |
$48,501.00
|
| Rate for Payer: Quartz Medicare Advantage |
$32,334.00
|
| Rate for Payer: The Alliance Commercial |
$89,889.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32,334.00
|
| Rate for Payer: United Healthcare PPO |
$51,144.79
|
| Rate for Payer: Wellcare Medicare |
$32,334.00
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC
|
Facility
IP
|
$49,877.00
|
|
|
Service Code
|
MS-DRG 479
|
| Min. Negotiated Rate |
$17,941.25 |
| Max. Negotiated Rate |
$49,877.00 |
| Rate for Payer: Aetna Managed Medicare |
$17,941.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,022.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29,910.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,417.08
|
| Rate for Payer: Anthem Medicare Advantage |
$17,941.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,941.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,941.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,941.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,545.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,941.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36,348.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,941.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,941.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,941.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,941.25
|
| Rate for Payer: NAPHCARE Commercial |
$26,911.88
|
| Rate for Payer: Quartz Medicare Advantage |
$17,941.25
|
| Rate for Payer: The Alliance Commercial |
$49,877.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,941.25
|
| Rate for Payer: United Healthcare PPO |
$28,297.38
|
| Rate for Payer: Wellcare Medicare |
$17,941.25
|
|
|
BIOPSY ARM/ELBOW SOFT TISSUE 24065
|
Professional
|
$536.00
|
|
|
Service Code
|
CPT 24065
|
| Hospital Charge Code |
3013804
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.52 |
| Max. Negotiated Rate |
$691.20 |
| Rate for Payer: Aetna Commercial |
$509.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.96
|
| Rate for Payer: Aetna Managed Medicare |
$153.60
|
| Rate for Payer: Anthem Medicare Advantage |
$153.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$153.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$153.60
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cigna Commercial |
$509.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$268.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.60
|
| Rate for Payer: Health EOS Commercial |
$487.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$547.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$547.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$153.60
|
| Rate for Payer: Multiplan Commercial |
$428.80
|
| Rate for Payer: Preferred Network Access Commercial |
$509.20
|
| Rate for Payer: Quartz Beloit One Network |
$235.84
|
| Rate for Payer: Quartz Commercial |
$305.52
|
| Rate for Payer: Quartz Medicare Advantage |
$153.60
|
| Rate for Payer: The Alliance Commercial |
$652.80
|
| Rate for Payer: United Healthcare Medicaid |
$78.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$153.60
|
| Rate for Payer: WEA Trust Commercial |
$294.80
|
| Rate for Payer: WPS Commercial |
$691.20
|
|
|
BIOPSY ARM/ELBOW SOFT TISSUE 24066
|
Professional
|
$1,369.00
|
|
|
Service Code
|
CPT 24066
|
| Hospital Charge Code |
3013805
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$186.81 |
| Max. Negotiated Rate |
$1,773.45 |
| Rate for Payer: Aetna Commercial |
$1,300.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,177.34
|
| Rate for Payer: Aetna Managed Medicare |
$394.10
|
| Rate for Payer: Anthem Medicare Advantage |
$394.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.10
|
| Rate for Payer: Cash Price |
$410.70
|
| Rate for Payer: Cash Price |
$410.70
|
| Rate for Payer: Cigna Commercial |
$1,300.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$684.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$394.10
|
| Rate for Payer: Health EOS Commercial |
$1,245.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,385.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,385.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.10
|
| Rate for Payer: Multiplan Commercial |
$1,095.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,300.55
|
| Rate for Payer: Quartz Beloit One Network |
$602.36
|
| Rate for Payer: Quartz Commercial |
$780.33
|
| Rate for Payer: Quartz Medicare Advantage |
$394.10
|
| Rate for Payer: The Alliance Commercial |
$1,674.92
|
| Rate for Payer: United Healthcare Medicaid |
$186.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.10
|
| Rate for Payer: WEA Trust Commercial |
$752.95
|
| Rate for Payer: WPS Commercial |
$1,773.45
|
|
